Coronavirus Disease 2019 (COVID-19) Daily Situation Report of the Robert Koch Institute

13/01/2021 - UPDATED STATUS FOR GERMANY

Vaccination DIVI-Intensive care Confirmed cases 7-day incidence (7-di) monitoring register

No. of districts No. of Change to previous Total1 Active cases2 Total population with 7-di vaccinations in day for cases > 50/100,000 pop last 24h4 currently in ICU +19,600 -8,100 155 -2 +69,178 -45 (1,953,426) [ca. 314,200] cases/ 100,000 pop [407/412] [5,185] No. of districts Total no. of Completed ICU 60-79 80+ Recovered3 Deaths with 7-di vaccinated with treatment; years years > 100/100,000 pop one vaccine dose4 thereof deceased [%] +26,600 +1,060 122 303 -23 758,093 +666 (ca. 1,596,600) (42,637) cases/ 100,000 pop [319/412] 32 %

Numbers in () brackets show cumulative values, numbers in [] brackets show current values. 1 The difference to the previous day relates to data entry at RKI; due to delay in data transmission former cases may be included. 2 Active cases were calculated from the number of transmitted cases minus deaths and the estimated number of recovered cases. 3 The algorithm for estimation of recovered cases considers information about disease onset and hospitalization but not for late effects because such data were not recorded regularly. 4 Data on COVID-19 vaccinations are only updated on weekdays. On Sunday, no updated figures are reported.

COVID-19 cases are notified to the local public health department in the respective districts, in accordance with the German Protection against Infection Act (IfSG). The data are further transmitted through the respective federal state health authority to the Robert Koch Institute (RKI). This

situation report presents the uniformly recorded nationwide data on laboratory-confirmed COVID-19 cases transmitted to RKI.

– Changes since the last report are marked blue in the text – Summary (as of 13/01/2021, 12:00 AM) • Currently, the number of transmissions in the population in Germany is high. RKI now judges the level of threat to the health of the general population as very high. • Yesterday, 19,600 new laboratory-confirmed COVID-19 cases as well as 1,060 new deaths associated with COVID-19 were transmitted to the RKI in Germany. The national 7-day incidence is 155 cases per 100,000 population. In Saxony and Thuringia, it is markedly above the national incidence. • All 412 districts have a high 7-day COVID-19 incidence. 319 districts have an incidence of >100 cases/100,000 population and of these, 54 districts have an incidence of >250-500 cases/100,000 population, and two districts have an incidence of >500 cases/100,000 population. • The 7-day incidence of people 60-79 years is currently 122 and of people ≥80 years 303 cases/100,000 population. • The high nationwide number of cases is caused by increasingly diffuse transmission, with numerous clusters especially in households, occupational settings and nursing and long-term care homes. • On 13/01/2021, 5,185 COVID-19 patients were in intensive care. In the preceding 24 hours, 666 existing patients had been discharged (32 % of whom had died) and 621 patients were newly admitted. The resulting number of cases under treatment was 45 less than the prior day. • Since 26/12/2020 a total of 758,093 people in Germany have been vaccinated against COVID-19 (9.1 vaccinated per 1,000 population) (http://www.rki.de/covid-19-impfquoten).

Note: The report is a snapshot and is continuously updated.

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Epidemiological Situation in Germany

In accordance with the international standards of WHO1 and ECDC², the RKI considers all laboratory confirmations of SARS-CoV-2 and confirms these via nucleic acid based (e.g. PCR) or direct pathogen detection, irrespective of the presence and severity of clinical symptoms, as COVID-19 cases. Thus, in the following report the term "COVID-19 cases" covers acute SARS-CoV-2 infections as well as cases of COVID-19 disease. General current assessment Since the beginning of December, there has been a renewed sharp rise in the number of cases. During the holidays, the number of cases decreased. In the last few days, the number of cases has risen again. Whether this trend will continue, beyond the expected retesting and re-reporting, will only become clear in the course of the next few days. The R-value is currently around 1. Due to the very high number of infected persons in Germany, this means a high number of new infections per day. Outbreaks are being reported from various districts throughout Germany, currently particularly in nursing and long-term care homes, occupational settings and households. Additionally, in many districts, there is an increasingly diffuse spread of SARS-CoV-2 without traceable transmission chains. Since patients in older age groups more often have more severe illness due to COVID-19, the number of serious cases and deaths remains on a high level. These can be avoided if all prevent the spread of the SARS-CoV-2 virus with the help of infection control measures. It is therefore still necessary for the entire population to be committed to infection prevention and control, e.g. by consistently observing rules of distance and hygiene - also outdoors -, by ventilating indoor spaces and, where indicated, by wearing a community mask correctly. Crowds of people - especially indoors - should be avoided. On 19/12/2020, a new virus variant (B.1.1.7) was reported in the UK. To date, it is unknown how the new virus variant will affect the COVID-19 pandemic. Cases with the new variant have already been detected in numerous countries around the world. So far, a few cases of this new variant in Germany have been reported to the RKI. Further cases may be expected. WHO has also reported another new virus variant detected in South Africa possibly associated with higher transmissibility and more severe disease. Isolates of this lineage have also been identified sporadically in Germany.

1 World Health Organization, https://www.who.int/publications/i/item/WHO-2019-nCoV-Surveillance_Case_Definition-2020.1 ² European Centre for Disease Prevention and Control, https://www.ecdc.europa.eu/en/covid-19/surveillance/case-definition

Note: The report is a snapshot and is continuously updated.

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Geographical distribution of cases Epidemiological analyses are based on validated cases notified electronically to the RKI in line with the Protection Against Infection Law (Data closure: 12:00 AM daily). Since January 2020, a total of 1,953,426 (+19,600) laboratory-confirmed cases of COVID-19 have been reported to and validated by the RKI (Table 1).

Table 1: Number and cumulative incidence (per 100,000 population) of laboratory-confirmed COVID-19 cases and deaths for each federal state electronically reported to RKI, Germany (13/01/2021, 12:00 AM). The number of new cases includes positive cases notified to the local health department at the same day, but also at previous days.

Cumulative cases Last 7 days Cumulative deaths 7-day Total Cases/ Cases in Number of Number of incidence/ Number of Federal State number of 100,000 the last deaths/ new cases* 100,000 deaths cases pop. 7 days 100,000 pop. pop. Baden-Wuerttemberg 264,735 2,226 2,385 14,397 130 5,758 51.9 Bavaria 361,582 2,778 2,755 19,390 148 8,216 62.6 Berlin 108,295 1,069 2,951 6,737 184 1,635 44.6 Brandenburg 52,285 764 2,073 5,791 230 1,361 54.0 Bremen 14,469 86 2,124 570 84 226 33.2 Hamburg 41,350 390 2,238 2,210 120 851 46.1 Hesse 152,844 1,551 2,431 9,430 150 3,716 59.1 Mecklenburg- 15,316 434 952 1,964 122 260 16.2 Western Pomerania Lower Saxony 122,431 1,328 1,532 8,639 108 2,442 30.5 North Rhine-Westphalia 435,464 3,657 2,426 25,445 142 8,402 46.8 Rhineland-Palatinate 81,737 698 1,997 5,418 132 1,870 45.7 Saarland 22,279 137 2,258 1,741 176 566 57.4 Saxony 158,624 1,947 3,896 12,395 304 4,323 106.2 Saxony-Anhalt 39,233 913 1,788 5,096 232 949 43.2 Schleswig-Holstein 29,250 405 1,007 2,734 94 594 20.5 Thuringia 53,532 1,217 2,509 6,916 324 1,468 68.8 Total 1,953,426 19,600 2,349 128,873 155 42,637 51.3 Quality checks and data cleaning by the health authorities and regional offices can lead to corrections to cases previously transmitted (e. g. detection of duplicate reports). This can occasionally lead to negative values for the number of new cases. * In Brandenburg, some health authorities experienced a backlog in data entry and thus in data transmission to the RKI. In some cases, this leads to large discrepancies between locally reported incidences and case numbers compared to those reported by the RKI.

Distribution of cases over time The first COVID-19 cases in Germany were notified in January 2020. Figure 1 shows COVID-19 cases transmitted to RKI according to date of illness onset from 01/03/2020 onwards. Of these cases, the onset of symptoms is unknown for 1,073,960 cases (55 %) thus their date of reporting is provided in Figure 1.

Note: The report is a snapshot and is continuously updated.

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Figure 1: Number of COVID-19 cases in Germany electronically reported to the RKI by the date of symptoms onset or – if unknown – alternatively by date of reporting since 01/03/2020 (13/01/2021, 12:00 AM). Outbreaks An increased incidence of >25 cases in 7 days/100,000 population was reported in all 412 districts. There are 54 districts with incidences of >250 to 500 cases/100,000 in the last 7 days and there are two districts with an incidence of >500 cases/100,000 in the last 7 days. The dashboard shows all affected districts (https://corona.rki.de). In most districts, the transmission is diffuse with many outbreaks particularly in retirement and nursing homes, occupational settings and private households. In some counties, a specific, larger outbreak is known to be the cause of the high incidence. Many smaller outbreaks continue to contribute to the elevated incidence, for example outbreaks in hospitals. Estimation of the reproduction number (R) The reproduction number, R, is defined as the mean number of people infected by one infected person. The estimation of the R-value is based on the so-called nowcasting (Figure 2), a statistical procedure that shows the development of the number of cases after the onset of the disease and also forecasts it for the last few days. This forecast is subject to uncertainty, which is also reflected in the prediction intervals given for the R-value. After other case reports have been received at the RKI, the R-value is adjusted for the past days and, if necessary, corrected upwards or downwards. In recent weeks, values reported at the beginning of a week were typically corrected slightly upwards. They had thus slightly underestimated the real COVID-19 events in Germany, values estimated towards the end of a week were more stable. The currently estimated course of the R-value is shown in Figure 3.

4-day R-value 7-day R-value 0.82 1.02

(95%-prediction interval: 0.68 – 0.93) (95%-prediction interval: 0.94 – 1.09) Delays in reporting of case numbers at weekend days can lead to cyclical fluctuations of the 4-day R-value. The 7-day R-value is less affected because all week days are used to determine the value.

Note: The report is a snapshot and is continuously updated.

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Figure 2: Number of notified COVID-19 cases with known date of illness onset (dark blue), estimated date of illness onset for cases without reported date of onset (grey) and estimated number of not yet notified cases according to illness onset electronically reported to RKI (orange) (as of 13/01/2021, 12 AM, considering cases up to 09/01/2021).

Figure 3: The estimated R-values (in green and orange) over the last 60 days, against the background of estimated number of COVID-19 cases according to illness onset (as of 13/01/2021, 12 AM, considering cases up to 09/01/2021).

The R-value is currently around 1. Due to the very high number of infected persons in Germany, this means a high number of new infections per day. Sample calculations as well as an excel sheet presenting both R-values with daily updates can be found under www.rki.de/covid-19-nowcasting. A detailed description of the methodology is available at https://ww.rki.de/DE/Content/Infekt/EpidBull/Archiv/2020/17/Art_02.html (Epid. Bull, 17 | 2020 from 23/04/2020).

Note: The report is a snapshot and is continuously updated.

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DIVI intensive care register

The German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) has in collaboration with RKI established a registry to document the number of available intensive care beds as well as the number of COVID-19 cases treated in participating hospitals on a daily basis. Since 16/04/2020, all hospitals with intensive care beds are required to report (https://www.intensivregister.de/#/index). As of 13/01/2021, a total of 1,282 hospitals or departments reported to the DIVI registry. Overall, 26,991 intensive care beds were registered, of which 22,570 (84 %) are occupied, and 4,421 (16 %) are currently available. The number of COVID-19 cases treated in participating hospitals is shown in Table 2.

Table 2: COVID-19 patients requiring intensive care (ICU) recorded in the DIVI register (13/01/2021, 12:15 PM). Number of Change to previous day* patients Currently in ICU 5,185 -45 Currently - thereof with invasive ventilation 2,970 (57 %) -30 New admissions to ICU +621

Discharged from ICU 58,223 +666 Total - thereof deaths 15,883 (27 %) +216 (32 %) *The interpretation of these numbers must consider the number of reporting hospitals and therefore the number of reported patients may change from day to day. On certain days, this can explain an occasionally important decrease or increase in the cumulative number of discharged patients or deaths compared with the day before.

Surveys on SARS-CoV-2 laboratory tests in Germany

To assess the SARS-CoV-2 PCR test numbers, data from university hospitals, research institutions as well as clinical and outpatient laboratories throughout Germany are merged weekly at the RKI. These data are ascertained on a voluntary basis and are transmitted to RKI via an internet-based RKI test laboratory survey, via the network for respiratory viruses (RespVir), via the laboratory-based SARS-CoV-2 Surveillance established at the RKI (an extension of the Antibiotic Resistance Surveillance (ARS)) and via the enquiry of a professional association of laboratory medicine. Since the beginning of testing in Germany up to and including week 01/2021, 36,353,196 PCR-laboratory tests have been recorded to date, 2,022,775 of which have tested positive for SARS-CoV-2. Up to and including week 01/2021, 258 laboratories have registered for the RKI test laboratory survey or in one of the other transmitting networks and transmit data upon reminder largely on a weekly basis. Since laboratories can register and correct the tests of the previous calendar weeks at a later date, it is possible that the ascertained numbers can increase retrospectively. It should be noted that the number of tests is not the same as the number of persons tested, as the data may include multiple tests of individual patients (Table 3 with data for the last 10 weeks – complete data since beginning of testing are available at http://www.rki.de/covid-19-testzahlen (in German)). As testing criteria were adapted to the current situation of limited testing capacities in face of high case numbers and to take into account the common cold season, from week 46 onwards the proportion of positive tests cannot be compared directly to former weeks (Adapted testing criteria: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Teststrategie/Testkriterien_Herbst_W inter.html in German).

Note: The report is a snapshot and is continuously updated.

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Table 3: Number of SARS-CoV-2-laboratory tests in Germany (as of 12/01/2021 12:00 pm) Number of Tested Proportion positive Calendar week Number of tests reporting positive (%) laboratories Up to & including week 44 23,157,258 611,564 45/2020 1,598,527 124,869 7.81 201 46/2020* 1,396,088 125,200 8.97 199 47/2020* 1,367,570 127,742 9.34 199 48/2020* 1,353,980 125,451 9.27 203 49/2020* 1,329,716 135,062 10.16 203 50/2020* 1,445,671 165,953 11.48 201 51/2020* 1,612,673 185,669 11.51 206 52/2020* 1,076,581 138,751 12.89 202 53/2020* 804,617 127,805 15.88 197 01/2021* 1,210,515 154,709 12.78 193 Total 36,353,196 2,022,775 *Change of testing criteria on 03/11/2020 – Limited comparability to previous weeks

Risk Assessment by the RKI

In view of persistently high case numbers, the RKI now judges the threat to the health of the general population to be very high. The revised version highlights the increasingly diffuse SARS-CoV-2 transmission as well as the occurrence of outbreaks especially in households, occupational settings and nursing and senior care homes. Therefore, more rigorous case finding and contact tracing as well as better protection of vulnerable groups is essential. Vulnerable persons can only be reliably protected if the number of new infections can be reduced substantially. On 12/01/2021, the risk assessment was updated with reference to the new SARS-CoV-2 variants. The current version can be found here: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Risikobewertung.html (in German)

Measures taken in Germany

- Recommendations on COVID-19-vaccination (08.01.2020. in German) https://www.rki.de/DE/Content/Infekt/Impfen/ImpfungenAZ/COVID-19/Impfempfehlung- Zusfassung.html - Further governmental resolutions regarding additional containment measures (Lockdown. 05/01/2021. in German) https://www.bundesregierung.de/breg-de/themen/coronavirus/mpk- beschluss-corona-1834364 - Vaccination started in Germany on the 26th of December 2020 http://www.rki.de/covid-19-impfquoten (in German) - Regulation to protect against entry-related infection risks regarding novel mutations of the coronavirus SARS-CoV-2 (21/12/2020. in German) https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/C/Coronavirus/Ve rordnungen/CoronaSchV_BAnz_AT_21.12.2020_V4.pdf - Information on the designation of international risk areas https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Risikogebiete_neu.html

Note: The report is a snapshot and is continuously updated.

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- Third law on protection of the population in the event of an epidemic of national concern (18/11/2020. in German) https://www.bundesgesundheitsministerium.de/service/gesetze-und- verordnungen/guv-19-lp/drittes-bevoelkerungsschutzgesetz.html - National Testing Strategy – who will be tested for SARS-CoV-2 in Germany (30/11/2020. in German) https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Teststrategie/Nat-Teststrat.html - Important information and guidance on the novel coronavirus SARS-CoV-2 for returning travellers (08/11/2020) https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Transport/BMG_Merkblatt_Reise nde_Tab.html - Selected and regularly updated information on COVID-19 https://www.rki.de/EN/Content/infections/epidemiology/outbreaks/COVID-19/COVID19.html - The ministry of health has published a record of all measures implemented in Germany since 27/01/2020 (in German) https://www.bundesgesundheitsministerium.de/coronavirus/chronik-coronavirus.html - Information from the Ministry of Health for travellers entering Germany: Frequently asked questions and answers (in German) https://www.bundesgesundheitsministerium.de/coronavirus-infos-reisende/faq-tests- einreisende.html - Corona-Warn-App https://www.rki.de/EN/Content/infections/epidemiology/outbreaks/COVID-19/CWA/CWA.html - Information on additional regulations at the regional level regarding control measures such as physical distancing or quarantine regulations for persons entering from other countries can be accessed here (in German): https://www.bundesregierung.de/breg-de/themen/coronavirus/corona-bundeslaender-1745198 - Data on current disease activity can be found on the RKI dashboard: https://corona.rki.de/

Note: The report is a snapshot and is continuously updated.